<div id="main" class="palm-hasheader">
	<div id="header" class="palm-header"></div>

	<div class="palm-group unlabeled">
		<div class="palm-list">
		

			<div class="palm-row first">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Questions to ask</div>
					<div class="label right">Check if correct</div>
				</div>
		</div>	
		
			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">What is your age?</div>
					<div id="ageCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>	

	
			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Time to the nearest hr?</div>
					<div id="timeCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>	
		
				<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">What is the year? ?</div>
					<div id="yearCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>


		</div>	
			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Name of this place? </div>
					<div id="placeCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>					
				
		
			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left"><span class="si">Give patient address to rpt at end of test</span></div>
				</div>
		</div>


							
	<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">What is yr b'day (date/month)?</div>
					<div id="bdayCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>	

			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">When did 1st World War begin?  </div>
					<div id="fwwCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>			
		
		
	
			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Name monarch/pm/president?</div>
					<div id="kingCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>	


			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Can patient identify 2 people? </div>
					<div id="recogCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>			
			

			<div class="palm-row">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Count from 20 backwards to 1 </div>
					<div id="countCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>			
		
		
			<div class="palm-row last">
				<div class="palm-row-wrapper" x-mojo-tap-highlight="momentary">
					<div class="label left">Recall address </div>
					<div id="addressCHK" x-mojo-element="CheckBox" class="right"</div>
				</div>
		</div>			
			
		
	</div>
	</div>


	<div id="calcButton" x-mojo-element="Button"></div>
	<div id="refButton" x-mojo-element="Button"></div>
</div>

